Addiction

CATR: To start, can you give us your take on the neurological process around pain? What’s going on in the brain that causes a patient pain?
Dr. Schubiner: All pain is generated by what the neuroscientists call a salience network, or as I like to call it, the danger alarm mechanism. All pain is real. It’s just a question of whether that pain is bein

REVIEW OF: May PA et al, JAMA 2018;319(5):474–482 New evidence suggests that the prevalence of fetal alcohol spectrum disorder is higher than previously documented. In this study, prevalence estimates were derived from 13,146 first-grade children in four U.S. communities between 2010 and 2016. The authors provide both conservative estimates (1%–5

REVIEW OF: O’Malley S et al, JAMA Psychiatry 2018;75(2):129–138 Acting on the nicotinic acetylcholine receptors, varenicline (Chantix) is an FDA-approved treatment for smoking cessation. These receptors are implicated in both nicotine and alcohol reward pathways, so could varenicline also be helpful for treating alcohol use disorder (AUD)? So far

REVIEW OF: Lintzeris N et al, J Addict Med 2018. doi:10.1097/ADM.0000000000000396 Recent guidelines published by the American Society of Addiction Medicine and nationally in Australia provide support for transferring patients from methadone to buprenorphine-naloxone (BNX). Patients may switch, thinking BNX is easier to discontinue or because of metha

Over the last few decades, doctors have done a better job at convincing their patients to stop smoking. But much of this improvement has been relegated to patients without mental illness. A recent study found that from 2004 to 2011, the U.S. smoking rate declined from 19.2% to 16.5% in people without mental illness, but the rate dipped only slightly in

CATR: To start, could you tell us a little about your work around substance use disorders, and specifically your experience with cannabis and adolescents? Dr. Gray: A large focus of my career has been on doing National Institutes of Health–sponsored research into better understanding substance use disorders in young people. So, that would include a

You’ve probably read about internet gaming disorder (IGD), and even heard about a man in Taiwan who died while continuously playing online games for 3 straight days (see http://cnn.it/2EJetN3). There’s still debate over how to classify and treat pathological gaming: Is it its own disorder, or just a symptom of another underlying mental illness? C

REVIEW OF: Goldenson NI et al, JAMA Pediatrics 2017;171(12):1192–1199 Considering them less lethal than traditional cigarettes, many adolescents are turning to electronic cigarettes as a “safer” alternative to tobacco products. In 2016, 11% of U.S. 10th graders reported using e-cigarettes for vaping. Adolescents who vape can inhale nicotine con

REVIEW OF: Topiwala A et al, BMJ 2017 Jun 6;357:j2353. doi:10.1136/bmj.j2353 It’s well established that long-term, heavy alcohol use can damage the brain and can cause problems such as Wernicke-Korsakoff syndrome and alcohol-related dementia. But what about the vast majority of our patients, who drink moderately? A recent study reports an associati

A recent study in The Lancet appears to conclude that Vivitrol (extended release naltrexone) and Suboxone (buprenorphine/naloxone) are equally effective treatments for patients with opioid use disorders (Lee JD et al, The Lancet 2018;391(10118):309–318)—at least this is how the study has generally been reported. But a deeper dive into the study reve

CATR: To start, can you please tell us a little more about your work at Harvard and Mass General? Dr. Kelly: Sure. I’m a clinical psychologist by training, and for the past 20 years, I have spent a lot of time researching the addiction treatment and recovery processes. I’ve looked at the effectiveness of different treatments, their mechanisms, an

Gabapentin (Neurontin) is a “novel anticonvulsant” and is FDA indicated for partial seizures and post-herpetic neuralgia. But the drug has long been heavily marketed to psychiatrists to treat a range of conditions from bipolar disorder to anxiety to alcohol withdrawal. It’s often seen as a “non-addictive” ­off-label drug useful for treating a

REVIEW OF: Jayawardena R et al, Hum Psychopharmacol 2017;32(3). Epub 2017 Jun 1. As clinicians, we’re more interested in preventing excessive drinking than curing hangovers. But it’s always nice to have some helpful advice for patients, which we found in a recently published literature review of clinical trials of hangover treatments. The auth

REVIEW OF: Miranda A and Taca A, Am J Drug Alcohol Abuse 2017:1–8 A challenging barrier for patients with opi­oid use disorders is the discomfort that can occur during the “induction phase” of their treatment, which is the period between discontinuation of opioids and initiation of medication-assisted therapy (MAT). Difficulties with induction

As an OB/GYN physician with a special interest in opioid use disorders during pregnancy, I see many women of childbearing age who are struggling with a substance use disorder. Some of these women are contemplating pregnancy, while others are already pregnant. I often collaborate with psychiatrists when treating these women, and I enjoy sharing knowledge

CATR: As both an addiction medicine physician and an obstetrician, you are in a unique position to advise other physicians about controlled substance use and pregnancy. What would you say are some of the most frequent questions you’re been asked by other physicians?
Dr. Christensen: Typically, the most frequent problem that I’m referred is the preg

REVIEW OF: Kamboj SK et al, Int J Neuropsychopharmacol 2017;20(11):936–947 Mindfulness is a growing trend in mental health treatment, but it often requires hours of practice to become proficient. What if you could provide your patients with an introductory mindfulness lesson in less than 15 minutes and see meaningful reductions in their risky drink

Detox (also known as “medically supervised withdrawal”) refers to treatment to help patients withdraw from substances that cause physical dependence, such as alcohol, sedative-hypnotics, and opioids. But detox is far more than a several-day process of ridding the body of an addictive substance. It should be considered an important component in the o

CATR: So, what do you feel is the big-picture challenge of treating heavy cannabis users? Dr. Hill: A big challenge is helping heavy users understand that cannabis use disorder is a real thing. It is hard for people to appreciate the risks that are associated with heavy use when they hear about the medical benefits and the recreational aspects of can

Kratom (Mitagyna speciose) is a tropical evergreen tree in the coffee family whose leaves have been used for centuries in South Asian countries as a stimulant and pain reliever. Recently, kratom has entered US and European markets and is now sold in various forms, both online and at local head shops. Because kratom possesses opioid-like properties, b

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Dr. Arnaout is an assistant professor of psychiatry at the Yale School of Medicine. He completed medical school at the Jagiellonian University in Kraków, Poland; trained in psychiatry at St. Luke’s-Roosevelt Hospital Center in New York, where he also completed the Intensive Psychoanalytic Psychotherapy Program at the William Alanson White Institute of Psychiatry, Psychoanalysis & Psychology. He then trained in addiction psychiatry at the Yale School of Medicine. He has co-edited two books on addiction psychotherapy that draw on the theoretical framework of motivational interviewing: Handbook of Motivation and Change: A Practical Guide for Clinicians (American Psychiatric Publishing, Inc., 2010) and Motivational Interviewing in Clinical Practice (American Psychiatric Association Publishing, 2017).